Provider Demographics
NPI:1437477684
Name:DAVIS, MARTIN (LPC)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:DAVIS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 KEYWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-3019
Mailing Address - Country:US
Mailing Address - Phone:601-933-1136
Mailing Address - Fax:601-948-3649
Practice Address - Street 1:513 KEYWOOD CIR
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-3019
Practice Address - Country:US
Practice Address - Phone:601-933-1136
Practice Address - Fax:601-948-3649
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS439101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health